MEDICARE: DR. TOMAS LUIS IZAGUIRRE III PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	42943	TX

General Provider Information

NPI Number	:	1942200738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMAS LUIS IZAGUIRRE III PHARM.D.

Provider Business Mailing Address
First Line	:	1530 SERENE DR
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-8049
Country	:	US
Telephone Number	:	956-722-0915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 MATAMOROS ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-5053
Country	:	US
Telephone Number	:	956-726-4512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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